Flows are high, and fishing will be tough in such rough conditions. You could try a stonefly nymph lower in the the river around 160.
Above Pagosa, fishing will be a bit easier on the upper sections and tributaries. A stonefly/mayfly nymph rig is a good combo, but tight line or euro setups can be pretty deadly as well.
Patterns/Bugs:
Nymphs: Prince nymphs 10-16, Runt Stone Golden 12-16, Pats Rubberlegs 6-12, 20 Incher 10-14, Flashback Pheasant Tail 14-20, Soft Spot Jig 12-16, Jigged Pats 8-12, Duracell 12, Napoleon Jig 14-16, Blowtorch Jig 10-18.
Early spring when flows are not too bad can be decent when fishing big flashy stonefly nymphs. The lower Piedra can get dirty very quickly though, so watch those flows. Any bump will cause discoloration or downright blowout.
Patterns/Bugs:
Nymphs: Prince nymphs 10-16, Runt Stone Golden 12-16, Pats Rubberlegs 6-12, 20 Incher 10-14, Flashback Pheasant Tail 16-20, Soft Spot Jig 12-16, Jigged Pats 8-12, Duracell 12, Napoleon Jig 14-16, Blowtorch Jig 10-18.